Guest Post – On dealing with doctors07/26/2010 at 6:02 pm | Posted in Uncategorized | 10 Comments
Tags: doctors, experts, female sexual dysfunction, Feminism, FSD, guest post, health, medicine, pain, sexual dysfunction, sexual health, vulvar vestibulitis, vulvodynia
Dear internet, we have a guest poster today! The following was written by Simone, who blogs over at Notes for a Feminist Rebellion.
I’m a twenty-something aspiring mathematician, who roams the internet under the name of Simone Lovelace. I am Jewish, bicurious, and whiter than the day is long. I’m in a long-distance relationship with a wonderful man, and I have female sexual dysfunction.
I’ve had dyspareunia (pain with vaginal penetration) since I first became sexually active. Over the years, I’ve tried a number of do-it-yourself treatments. I’ve gone through gallons of lube, tried increasingly bizarre positions, and switched to all-cotton panties. Nothing worked. Finally, this spring, I decided to see a doctor.
Since then, I’ve visited several medical professional in two U.S. states. I still don’t have a diagnosis, and the treatments I’ve tried have been useless. Right now, I’m not too concerned about this. Dealing with FSD is a process. If it takes me a while to find the right treatment, then c’est la vie.
One of the things that has surprised me most in my FSD journey is the range of attitudes I’ve experienced from my doctors. These have run the gamut from compassionate and respectful to judgmental and mildly sadistic.
Finding a supportive doctor can be a crucial step in managing FSD. On the one hand, dealing with a judgmental doctor can be incredibly painful. On the other, a compassionate doctor can be invaluable—particularly for someone with a condition as complex and personal as FSD.
When I first sought help for my FSD, I was finishing college in southern California, and the on-campus clinic was my only real option. I called up Student Health Services, and got an appointment with a woman I’ll call Dr. H.. Unfortunately, as it turned out, working with Dr. H. was more traumatic than helpful.
Dr. H. was judgmental about my sexual choices, and inconsiderate of my feelings. During my first appointment, I told her about my symptoms, and gave her an outline of my sexual history. Since I was menstruating, Dr. H. couldn’t give me a physical exam that day, but that didn’t stop her from speculating about possible diagnoses. There are a number of conditions that cause dyspareunia, most of which are quite treatable. Some are sexually transmitted diseases, but many are not. Dr. H., however, mentioned only two possibilities.
“Well,” she said, “That could be herpes, or HPV. I’ll have to run some tests.”
I was shaken. It was as though I’d come in with a headache, and been told, “Well, it could be cancer.” An untreatable STD was my personal worst case scenario. I wasn’t worried for myself, so much as terrified that I might have given my boyfriend an incurable infection. We’d always played it safe, but my protection had failed me before. Despite using condoms with every partner, I had gotten a case of chlamydia in the past year.
It’s possible that Dr. H. was simply ignorant of the many conditions that cause dyspareunia, all except HPV and herpes. However, it seems implausible that a doctor would be unaware, for example, that insufficient lubrication causes sexual pain. To me, it’s far more likely that her bizarre behavior was the result of bias.
In retrospect, I’m pretty sure Dr. H. disapproved of my sexual choices. Most likely, she saw me as irresponsible and promiscuous—a “slut.” In American culture, we have an unfortunate tendency to view STD’s as punishment for deviant sexual behavior. Perhaps it was Dr. H.’s whorephobia that lead her to focus on the possibility of that I might have an STD, and ignore other options. And perhaps it was the same prejudice that prompted her to be so cavalier about what, for me, could have been a devastating diagnosis of herpes or HPV.
When I was about to leave, Dr. H. asked me about my positive chlamydia test. I told her that I wasn’t sure how it had happened, but that I’d taken antibiotics, which had cured the infection. Dr. H. responded with a few words of wisdom.
“Given your history,” she said, “the most important thing is that you minimize your number of sexual partners, and practice safe sex.”
Now, safe sex is a good thing. And I don’t think it’s unreasonable to advise someone whose STD status is uncertain to be abstinent. But judging from Dr. H.’s phrasing, she seemed to think I was barebacking with a new man every night. I had already told her that I was in a monogamous relationship, and that I always used protection. Being accused of promiscuity didn’t phase me; what bothered me was being accused of infidelity, and called a liar to boot.
As her comments indicate, Dr. H. used my “history” as an excuse for making wild assumptions about my lifestyle and my physical health. This sort behavior is both immoral and dangerous. A doctor who is busy passing judgement on her patients’ personal lives is in no position to provide quality medical care.
In addition to being judgmental, Dr. H. was indifferent to my pain. She never showed sympathy, even when I was in obvious distress. During our second appointment, she gave me a pelvic exam. Naturally, I found this very painful, and I whimpered a little. At this, Dr. H. asked if the pain was similar to what I felt during sex. When I told her it was, her response was simply “Oh.”
After the exam, Dr. H. told me that everything was normal, and I was free to go. When I asked if there was anything more she could do, Dr. H. responded that painful intercourse was just an issue “some girls have.” She then suggested that my problem could be psychological, and that I might need anti-anxiety medication.
Dr. H.’s claim that dyspareunia was simply a problem “some girls have” was both ignorant and hurtful. It was irresponsible to suggest that I give up hope, just because the exam had turned up nothing. At the very least, she could have told me there was nothing she could do, and referred me to a local gynecologist.
When she dismissed dyspareunia as something “some girls have,” Dr. H. was implicitly refusing to treat the pain itself. There are numerous techniques for managing vulvar pain, from acupuncture to topical anesthetics. But Dr. H. wasn’t interested in treating my symptoms. Vaginal pain, in and of itself, didn’t strike her a something that warranted her attention.
Finally, Dr. H.’s comment about my pain being psychological was absurd. While FSD may have a psychological component, it is rarely a purely psychological problem. Dr. H. had no reason to assume that my pain was of psychological origin, or to recommend psychotropic drugs.
That appointment was the last I saw of Dr. H.. My STD tests, incidentally, came back negative.
I’d like to say that my experience with Dr. H. was a fluke, but I’ve heard similar stories from other women with FSD. It seems that many of us face the sort of problems I encountered with Dr. H.. American culture has highly repressive views about women’s sexuality, so perhaps it’s not surprising that women with FSD have a hard time obtaining medical care. Many doctors are simply uninformed about FSD; others are actively dismissive of women’s sexual issues. Too often, women with FSD must contend with doctors who judge us for our sexual choices; dismiss our problems as unimportant; or tell us that it’s all in our heads.
If at First You Don’t Succeed…
After graduation, I went home to Boston for the summer. There, I paid a visit to my usual healthcare provider, a physician assistant whom I’ll call Carol. In terms of treating my FSD, Carol was not very helpful. For starters, she didn’t give me a diagnosis. By this point, I had done a fair amount of research, and become convinced that I had vulvodynia, a vulvar pain disorder of unknown cause. In particular, my symptoms correspond to a subtype of vulvodynia called vestibulitis. While Carol did mention vulvodynia as a possibility, she made it clear that she knew little about the condition.
Although she wasn’t sure exactly what was wrong, Carol did prescribe some treatments. She gave me a set of vaginal dilators, which I’ve been using daily for the past few weeks, and an anesthetic cream to make dilation less painful. So far, these have proven essentially worthless. The cream burned badly on contact, and any subsequent numbing effect wore off too quickly to be useful. I soon decided I was better off dilating with it. Moreover, I’m skeptical of the dilation treatment itself. I don’t have muscle spasm or vaginal tightness, so why would I need to dilate?
I’m not too bothered by Carol’s inability to instantaneously cure my FSD. Carol is a P.A., not a specialist in vulvar pain disorders, and I didn’t expect her to give me a miracle cure. What I want to stress about Carol is that she was incredibly kind and respectful. During my visit, she was actively supportive in several key ways.
She was careful not to jump to conclusions. Carol took a detailed history, asked numerous questions, and gave me a physical exam. Only then did she begin suggesting possible diagnoses and presenting treatment options. This sort of diligence can be invaluable in any non-emergency medical situation. It’s particularly crucial in treating a complex, multi-factorial condition like FSD.
She took what I said seriously. Carol was never dismissive of my concerns, and she did not treat me with suspicion. Our conversation felt like an exchange, not like an interrogation.
Carol trusted me, even when I said things that didn’t fit the stereotypes about women with FSD. When she asked if I had any negative attitudes toward sex, I responded that I didn’t think that was an issue. I was comfortable with my sexuality, had no moral qualms about intercourse, and enjoyed non-penetrative sex. Carol took my answer at face value and moved on. I cannot overstate how much I appreciated that simple act of respect.
She was open and non-judgmental about sex. Strangely enough, there are still doctors who still blush at the word “vagina.” Carol, on other hand, seemed perfectly comfortable discussing my sexual anatomy.
In addition, Carol avoided expressing any judgement–positive or negative–about my sexual behavior. She showed no disapproval when I recounted my sexual history, and she did not praise me for using condoms. Her focus was always on easing my pain, not on policing my behavior.
Discussing ones sex life with a medical professional can feel embarrassing or demeaning. Due to Carol’s respectful attitude, I was comfortable engaging her in a frank, detailed discussion of my FSD.
She acknowledged that my FSD was a real issue. To Dr. H., my pain only mattered if it pointed to an underlying disease. Carol, however, understood that my pain was a problem in and of itself. She was warmly sympathetic when I told her my story, and proactive about trying to find me a good treatment. I’m not too optimistic about the treatments Carol prescribed for me. Nonetheless, her willingness to recommend treatment options sent a powerful message that she cared about my pain, and was invested in helping me heal.
In a perfect world, all medical professionals would be as genuine, thoughtful, and compassionate as Carol was to me. Sadly, many fail to do so. Sometimes, women with FSD may need to accept disrespectful behavior from doctors, just to get the medical care we need. But I think it’s important to hold our doctors to a high standard whenever possible. It’s important to remember that when we seek medical care, we deserve kindness and respect.
With that, I’d like to open up the discussion to you. Have you seen a doctor for your FSD? Was it a positive experience? Why or why not? What words of advice, encouragement, or warning would you give to women seeking treatment for FSD?